The growing obesity epidemic raises concerns in many sectors from healthcare to the food industry and even the business sector, and S. Holm considers the place of ethics within these conversations about interventions to combat obesity. “Obesity Interventions and Ethics” brings up the controversial debate whether health is good for everyone, regardless of individuals’ values. Similar to the conversation about informed consent, obesity interventions involve a conflict of values between autonomy, respect for personal choices, and promotion of the common good. Current policies such as the FDA’s forced phase out of trans fats by the food industry assume that being healthy is good for all citizens.[i] Governmental control on health and health decisions could be supported by the constitutional clause on promotion of general welfare. [ii] This argument of constitutional responsibility gives broad authority to the government to promote the general welfare, and in this context, general welfare could be seen as health. This sort of argument framework has been utilized in the debate on healthcare in the United States. Our nation is making a transition towards universal healthcare by enacting the Affordable Care Act. Therefore, our government is making claims that health is an important right and aspect of citizenship. Our nation is associating health with what is “good” and society members through payments and taxes are supporting this notion by merely being members of society.
In contemporary times, personal freedom is gaining emphasis as seen in the case of informed consent, and therefore, freedom surrounding people’s choices about their health and nutrition will be increasingly scrutinized.[iii] Current times will involve interesting interchange between personal freedoms and government promotion of health for all. There are nuances between government encouraging healthy choices and controlling the choices that society members make. For example, the FDA’s forced phase out of trans fats represents governmental control, or hard paternalism as defined by Finnish philosopher Heta Hayry. There is importance in Heta Hayry’s clever distinctions between the levels of paternalism: hard paternalism, soft paternalism, and maternalism, and these differing levels could be an important marker for evaluating public health policies. Soft paternalism and materialism are the most favorable because these still allow for pursuit of personal choice. A health campaign out of Hawaii, “Rethink Your Drink,” cultivates repugnance in soda drinkers by using controversial advertising techniques.[iv] This matneralistic method is more favorable in terms of the consumers’ freedoms and adherence and compliance. In comparison, Mayor Bloomberg’s proposed ban on sugary drinks which was seen as an overstep of power and was not passed due to its hard paternalistic nature. Instead of instilling empowerment and change, the law was challenged and ended in a victory for soda drink makers.[v] In context to the national assumption of health as good as mentioned previously, then I do believe that these acts of soft paternalism or maternalism are justified.
I think Holm’s article makes a good point about soft paternalism and maternalism but I think there needs to be a parallel focus on issues of accessibility and affordability for good health options and information. Quality interventions should deal with these aspects, and only when these areas are covered can an individual bear all responsibility for his or her own decisions. Holm’s mentions the circular and continuous debate over who holds responsibility for the obesity epidemic. Analysis in context to the constitutional argument, the United States bears a portion of responsibility in the individual’s choice. Therefore, an appropriate and efficient intervention will need to ensure that options presented are affordable, accessible (in terms of both material items and information) as well as not presented in a controlling manner. Environment has a huge influence on how people make decisions, and soft paternalism or maternalism interventions can only initiate movement for change if certain things, such as food options, are available or affordable or else these interventions are in vain. The “Rethink your Drink” campaign was a success because the means for the campaign are available to all—cutting out sugary drinks and replacing them with water.
Thus, in order for a soft paternalistic or maternalistic intervention to be a success people need to have the means to follow through with the behavioral changes and from there on out, the responsibility lies in the hands of the consumer. As with discussion about informed consent, from this point there needs to be respect for the consumer’s decision, especially in this ideal intervention method. While I believe these other aspects of the intervention technique are possible, I think respect will be the largest issue in applicability. Holms highlights this issue through conversation about stigmatization; respect is difficult to cultivate when people misunderstand other’s choices and tradeoffs or an individual’s sense of well-being.
[iii] Veatch, Robert M. Abandoning Informed. Arguing About Bioethics. By Stephen Holland. New York: Routledge, 2012. 329-38. Print.